Influenza Virus Mashup

(Thu, 29 Oct 2009 18:16:00 +0000)

# 3905

Although we’ll get an update tomorrow in Friday’s FluView report,  today’s release of the MMWR indicates that 22 new pediatric influenza deaths were reported in the United States last week.  

Some of those may be from previous weeks, as sometimes there is a bit of lag time in testing and reporting. 

But the 5-year weekly average for this time of year is Zero. 

Week 42: 22 new deaths reported
Cumulative 2009: 192 total deaths reported
By states: WI (1), SD (1), GA (1), FL (1), TN (2), TX (9), MT (1), AZ (3), WA (1), OH (1), GU (1)

These would be considered extraordinary numbers in the middle of February, to be occurring in October is particularly worrisome.

 

Since August 31st, the total is sadly 74 children lost to this virus.

Pediatric influenza deaths are the only notifiable flu deaths in the US, and so we have a much better handle on how many really are occurring around the country.  

This is LAST WEEK’S chart (update comes tomorrow 10/30/09).

Via Prokerala.com: Six swine flu deaths in India raise toll to 463. Excerpt:

Six swine flu deaths, including five in Karnataka alone, were recorded Thursday, taking the total toll due to the Influenza A (H1N1) virus to 463 in India, health authorities said here. 

Apart from the five deaths in Karnataka, one death was also recorded in Maharashtra.
With the five deaths, the total number of people who have died due to the contagious virus in Karnataka has climbed up to 117. 

However, Maharashtra continues to top the list of states that record the highest number of deaths in the country since the first one was recorded Aug 3. With the one death, the toll has now risen to 197 in the state, where over 3600 people have been affected with the flu. 

Also, the country reported 75 new cases, taking the number of people affected with the flu to 13,722.

Via DNA India.com, a report from Mumbai: H1N1 is mutating, turning deadlier. Excerpt:

A preliminary study conducted by the state government into the deaths caused by the H1N1 influenza virus has revealed that the pathogen is now affecting patients more virulently and is producing newer reactions in the body. 

The study has also thrown up a perplexing fact–two-thirds of those suspected to have died of swine flu did not have the virus, despite showing all clinical symptoms. 

Pathologists at the state-run Sassoon General Hospital in Pune took tissue samples from the bodies of the deceased to study the effect of the virus that attacks the respiratory tract. 

“Our doctors have concluded that the virus has undergone some genomic changes,” said Dr Arun Jamkar, dean, BJ Medical College, Pune. A key discovery is that the virus, which was initially causing a bacterial infection, is now causing a more potent viral infection. 

“The viral is now leading to a condition called hyalinisation of alvelar membrane, or thickening of the lung wall by deposition of proteins. Due to this, oxygen supply is severely affected, and even ventilators have been of little help,” said Dr Pravin Shingare, joint director, Directorate of Medical Education and Research (DMER). 

The state experts have found that the deaths between August 3 and 25 were largely due to formation of pus on the membrane lining the lungs. “During that period, deaths were caused mostly due to a secondary bacterial infection,” said a professor who was involved in the study. But the deaths caused thereafter were the result of deposition of proteins on the membrane. 

“The deposition is more severe in the case of recent deaths. It leads to the thickening of the membrane, and therefore oxygen cannot not pass into the body at all,” the professor said. 

This finding has led experts to conclude that the virus has indeed undergone some changes and its anti-antigenicity is changing. 

But, the National Institute of Virology (NIV) in Pune has a different opinion. Director of NIV, Dr AC Mishra, said that his team is yet to record any change in the behaviour of the virus. “We still cannot say conclusively that the virus has mutated,” he added.

(Thu, 29 Oct 2009 15:39:00 +0000)

# 3904

The New Scientist debunks 8 dangerous swine flu myths in:

Swine flu: Eight myths that could endanger your life.  

Each myth has a link to a more detailed answer, so by all means follow them.  I’ve only reproduced the openings of the first 3, but all are worth reading.

Highly recommended.

MYTH 1

The symptoms are like regular flu. You’ve got it if you’ve got a fever

Up to half the people who get swine flu never develop a fever, and some suffer from gastrointestinal symptoms as well as more standard flu symptoms. Read more

 

MYTH 2

This is just mild flu. The death rates are even lower than for normal flu

Swine flu is killing young people rather than the very elderly, and although winter is just starting, more young people have already died of flu than normally die over the entire winter. Read more

 

MYTH 3

You’re safe as long as you’re healthy. Only sick, weak people get really ill

Most of the children who have died of swine flu were perfectly healthy beforehand, and many of the adult victims also had no underlying conditions. Read more

A hat tip to @Dutchy123 on Twitter for tweeting this article.

Via Thanh Nien Daily: Vietnam health ministry wary of widespread Tamiflu use.

Doctors are suggesting that Tamiflu be sold widely so that people can treat themselves at home, but the health ministry is concerned about the flu virus developing resistance to the drug. 

Nguyen Van Kinh, head of the National Institute of Tropical and Infectious Diseases, told a meeting on Wednesday that hospitals nationwide are overcrowded with influenza A patients, but 80 percent don’t need to stay there. 

His institute and several hospitals in Hanoi are grouping patients from different faculties together to have more space for swine flu patients, Kinh said. 

He said most of the flu in-patients, especially light cases, want to be treated from home but a current regulation only allows Tamiflu to be administered at medical centers and to hospitalized patients. 

Kinh said Tamiflu should be sold at commune or ward drugstores so that people can treat themselves at home under the supervision of local medical officials. 

Nguyen Hong Hanh, deputy head of the National Institute of Hygiene and Epidemiology, agreed, saying “rapid response teams” should be set up to take care of cases at home. 

Hanh said treatment at home will not only “lift the heavy burden from hospitals” but also prevent infection spreading between people visiting hospitals for examination. 

However Trinh Quan Huan, deputy minister of Health, said allowing Tamiflu to be used widely can lead to the virus developing drug resistance as is happening in around 15 countries. 

Huan said no country has allowed such usage of Tamiflu and the World Health Organization doesn’t recommend it either. 

“If the medicine is distributed widely among the community, no one can manage to make sure if people are using it exactly as prescribed. 

“When some people develop resistance to the medicine, we will have no weapon left to fight swine flu.”

Here is the October 29 HPA - Weekly pandemic flu media update. Excerpt:

•The flu-like illness rate in England from the Royal College of General Practitioners (RCGP) scheme increased to 42.8 per 100,000 in week 43 compared to 39.1 in week 42. An increase was seen in all age groups. 

•The main burden of flu-like illness nationally is in the 1-4 and 5-14 years age groups. 

•This week, the antiviral collection numbers in the National Pandemic Flu Service have continued to increase and this has been seen in all age groups. The largest increase (49%) in week 43, compared with week 42, was seen in the 1-4 year olds. 

•Interpretation of data to produce estimates on the number of new cases continues to be subject to a considerable amount of uncertainty. HPA modelling gives an estimate of 78,000 new cases in England last week (range 39,000 to 169,000). This represents a 56% increase on the previous week.
This estimate incorporates data from National Pandemic Flu Service and GP consultations. 

•The HPA estimates a cumulative total number of cases of 521,000 since the pandemic began.

Via Xinhua: A/H1N1 accounts for 80 pct of China’s total flu cases: official. Excerpt:

The A/H1N1 influenza virus is responsible for nearly 80 percent of China’s total flu infections and most of the mass cases occurred in schools, according to a senior official with the Ministry of Health (MOH).     

“As the weather keeps getting colder, many regions are entering the traditional period of possible flu outbreak, and prevention and control work is becoming tougher,” Liang Wannian, vice director of the health emergency office under the MOH, said Thursday during an online interview with the official website of the Chinese government.     

According to Liang, as of Wednesday, a total of 1,502 mass cases were reported in 31 provinces, municipalities and autonomous regions of the Chinese mainland and 96.4 percent occurred in schools.

“Mass cases” is a new expression to me. I assume it means a cluster of infections.

(Thu, 29 Oct 2009 13:40:00 +0000)

# 3903

For the past few days newshounds on the flu forums have been busily finding, and translating, articles from the Ukrainian and Russian press regarding an outbreak of an `unknown disease’ in the Ukraine, which has been blamed for as many as 22 deaths.

This disease has been described most frequently as `flu-like’ and `atypical pneumonia’, and so there is a strong likelihood that this is the novel H1N1 `swine’ flu virus – although that has not been established.

Translations from Russian to English are problematic at times, and we are seeing conflicting accounts, so until we learn more these reports should be viewed with a certain amount of skepticism.

The FluTrackers thread now has in excess of 66 posts over the past three days, as the newshounds compile and analyze these reports. A few excerpts from these reports below:

The first story was posted by Dutchy on October 27th.  Bear in mind that these are machine translations from the Russian language:

In Ukraine, from complications following an unknown form of flu deaths of seven people

Ternopil. October 27. INTERFAX-UKRAINE - In Ternopil region of Ukraine on October 26 from complications caused by flu, seven people died, said Tuesday the head of the regional health administration Bogdan Oniskiv.

 

At a press conference on Tuesday in Ternopil, he noted that almost all dead - the young, physically healthy people. “

 

He also informed that over the past few days in Ternopil with flu symptoms unknown to the medical institutions sought about 6 thousand people.

Over the next 24 hours the number of deaths reported escalated to 20, and we received conflicting reports as to whether this virus was H1N1.   Samples have reportedly been sent to a lab in London, and results are not due back for several days.

This report posted by Hogweed.

Health Ministry Confirms 20 Lethal Pneumonia Cases In Ternopil, Ivano-Frankivsk And Lviv Regions

(15:59, Wednesday, October 28, 2009)Ukrainian News Agency

The Ministry of Healthcare confirms 20 lethal cases of pneumonia in Ternopil, Ivano-Frankivsk and Lviv regions, first deputy health minister Vasyl Lazoryshynets, has told at a news conference.

 

He said that 95 people were taken to hospitals in Ternopil region since October 13, of them 25 in grave condition and 10 of them died.

In Ivano-Frankivsk region 25 people were taken to hospitals for the same period, seven in grave condition, six died.

 

In Lviv region 6 patients were taken to hospitals since October 1, of them two in grave condition, four died.

 

In his turn, first deputy health minister / chief sanitary officer Oleksandr Bilovol said that a high threshold of incidence rate of acute respiratory viral infection has been recorded for the last week and a half in these regions, specifically in Ternopil region the epidemiological threshold exceeded by one and a half times.

He says that at the moment they are searching for underlying causes of pneumonia for every of the lethal cases.

Bilovol expects results of the research in a week.

 

On Wednesday Vasyl Kniazevych, the health minister, has said that nine cases of death by pneumonia registered in Ternopil region by October 28, and also 95 people treated at hospitals with the same diagnosis.

 

As to the minister, suspicions of the А(H1N1) influenza virus were not confirmed.

 

As Ukrainian News earlier reported, the health ministry formed a commission to study reasons for the uprise in the incidence rate of influenza and acute respiratory viral infections in Ternopil region.

There are also conflicting reports over whether quarantines and travel restrictions have been imposed in the region.   Below is an updated report from today, posted by Dutchy.   

A couple of notes: The mention of SARS in these reports are an artifact from the translation software, and should be interpreted as ARVI - acute respiratory viral infection  (Hat tip Alert on FluTrackers).  Additionally, the use of Rapid Influenza diagnostic tests (RIDTs) to rule out H1N1 is an unreliable method.

In Western Ukraine, the number of deaths from viral pneumonia rises to 22 people, including two children

29. 10. 2009 | Kyiv, October 29. / Corr. ITAR-TASS Galina Nekrasov.

 

Two more deaths due to viral pneumonia registered in Ternopil and Lviv regions. Thus, the number of deaths from an unknown virus in the western regions of Ukraine has reached 22 people, the press service of the Ministry of Health of Ukraine. Almost doubled in the last day of the increased number of hospitalized. Hospitals are more than 130 people, of whom more than 30 in critical condition.

 

In all the western regions of the country set up mobile teams of the ambulance that identify patients and urging people not to engage in self-medicate. “If a patient on the first day, ask for help, then there is a 100 percent chance to save him,” said the chief sanitary doctor of Ukraine Alexander Bilovol.

The disease occurs rapidly, beginning with the high, up to 40 degrees, temperature, fever and chills, on the third day there asphyxiation and pulmonary insufficiency, developed bilateral pneumonia and pulmonary edema.

The disease is not treated with antibiotics, only new antiviral drugs, which in pharmacies there. They’re centrally transported to hospitals in the region. The cost of one day of treatment the patient is 10 thousand hryvnia / more than 1 thousand dollars.

 

Health Minister Vasyl Knyazevich argues that “rapid diagnosis does not confirm the strain of California virus A/H1N1 / in the three western regions. Analysis of patients sent to the virology laboratory in London. “Ukraine, as one of the countries of the European region, serves the laboratory.

 Obviously an interesting situation, and one that is being watched closely.  The most likely explanation here is the H1N1 virus, but we will have to await laboratory confirmation to know for sure.

Via Monsters and Critics: Morocco diagnoses 82 cases of swine flu in one day. Excerpt:

Eighty-two cases of the H1N1 influenza have been diagnosed in Morocco in a single day, press reports said Thursday. 

The cases were discovered in the cities of Casablanca, Fes, Meknes, Kenintra and Rabat on October 28, Health Minister Yasmina Badou was quoted as saying.

Via the Winnipeg Free Press: Two bad reactions from immunization in city. Excerpt:

The H1N1 vaccine isn’t for everyone.
Since the mass immunization began in Winnipeg Monday, two people have had rare allergic reactions to it, according to the Winnipeg Regional Health Authority. 

“We have had two incidents involving some allergic-type symptoms,” said Dr. Sande Harlos, a WRHA medical officer of health. “This is what we’re prepared to deal with.” 

The maker of the H1N1 vaccine, GlaxoSmithKline, warns that up to one in 1,000 doses may result in an allergic reaction leading to a “dangerous decrease of blood pressure.” 

“That’s why you’re asked to wait 15 minutes afterwards,” Harlos said. A severe reaction will happen within minutes of getting the shot. 

By 3 p.m. Tuesday, 15,695 Winnipeggers had been immunized without incident. When someone reacts badly to the vaccine, there are medical staff on hand to help, Harlos said.
The vaccine recipient is taken to hospital to be kept under observation. 

Harlos said the two people who reacted badly to the vaccine — one on Monday and one on Tuesday — are OK. “They left in good condition.”